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Full text of "Navy Department BUMED News Letter Vol. 5, No. 10, May 11, 1945"

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NavMed 369 




a digest of tiiaelij information 

Editor - Lt. Samuel Nesbitt, (MC), U.S.N.R. 

Vol. 5 

Friday, May 11, 1945 

No. 10 


Burns: Surgical Management 1 

Used Gas Masks and Canisters 5 

Streptococcal Diseases: Control 6 

Streptococci: Classification 7 

Hemophilia: Plasma Factor for 8 

Multiple Sclerosis: Fundi in 8 

Globin as a Blood Substitute 9 

Rest: Effect on Blood Volume 10 

Circulatory Response to Morphine ... .10 
Cancellous Bone Grafts 11 

Form Letters: 

The Metric System '....11 

Penicillin in Neurosyphilis 14 

Penicillin in Endocarditis 14 

Penicillin: Inactivation 15 

Rehydration of Survivors 16 

Hyperabduction of Arms: Effects.... 16 

Tularemia: Therapy 17 

Rheumatic Fever: P-R Interval 18 

New BuMed Publications 18 

Public Health Foreign Reports 20 

Immunization Against Yellow Fever BuMed.. 

Preparation and Submission of NavMed-4 ..... BuMed.. 

Processing of Repatriates Joint Ltr 


Surgical Management of Thermal Burns: The treatment of burns by mini- 
mal debridement, pressure dressings and plasma resuscitation is recommended 
as standard procedure. Tannic acid and other escharotics have been abandoned 
and are not to be used. 

The principle of infrequent dressings should be followed. A properly ap- 
plied initial dressing may be left in place for from 10 to 14 days. The period 
following immediately upon resuscitation is concerned with the treatment of im- 
pending infection and the correction of the systemic disturbances incident to-the 
injury. There is increasing clinical recognition of the later consequences of pro 
tracted initial anoxemia. It is still considered by some that a true toxemia may 

Burned News Letter, Vol. 5, No. 10 RESTRICTED 

exist in the early stages of a severe burn, but the "toxin" in the damaged 
tissue remains unidentified. Venous thrombosis and pulmonary infarction are 
recognized complications of serious burns. Fluid, protein, and sodium loss 
with progressive anemia characterize the immediate convalescence. Com- 
pensatory redistribution of body fluids is most active during the first week 
after injury. 

Penicillin is the chemotherapeutic agent of choice in the treatment of im- 
pending, or established, invasive infection in burns. The drug should be con- 
tinued until the wounds are healed by epithelialization or skin grafting. 
Systemic penicillin therapy should be employed; local penicillin therapy is not 
recommended. The sulfonamides have been abandoned in the treatment of burns, 
especially because of renal complications following their use. 

Removal of tissues destroyed by the burn is postponed of necessity until 
demarcation is apparent, usually at from 10 to 14 days. Surgical excision of 
sloughing tissue is preferable to the use of proteolytic (Dakin's solution) or 
macerating (saline) dressings. .Frequent dressings of granulating surfaces in- 
vite wound suppuration due especially to Ps. aeruginosa (pyocyaneus) or Proteus. 
The preferred method of management combines systemic penicillin therapy , 
irgical removal of devitalized tissue remnants, and the application of dry (not 
petrolatum) fine mesh gauze with pressure dressings, followed by skin grafting 
from 3 to 5 days later, 

It has been demonstrated that excessively high environmental temperature 
is poorly tolerated by patients with extensive burns. Naval installations in the 
tropics should anticipate the need for controlled temperature rooms. 

Emergency Treatment ; Contamination of burned surfaces with organisms 
from the nose and throat is responsible for some of the more serious infections. 
Masking of attendants to minimize contamination from this source should be 
done whenever practicable. 

The burned surface should be covered with a single layer of sterile mesh 
gauze (44-mesh gauze bandage is satisfactory). Over this should be added a 
thick layer of sterile gauze dressing, the large or small first-aid dressings 
being especially suitable for this purpose. Finally, a gauze or muslin band- 
age should be applied firmly over all. 

The prompt administration of plasma, when feasible, constitutes an impor- 
tant element in the emergency treatment of burns. 

Initial Surgical Management : Resuscitation: Anticipant or preventive 
therapy is preferable to corrective treatment for hemoconcentration or shock. 
The initial phase of resuscitation is accomplished with plasma. Blood trans- 
fusions are desirable in the later stages of resuscitation, especially if there is 

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Burned News Letter, Vol. 5, No. 10 RESTRICTED 

evidence of red blood cell destruction. The fluid and nutritional therapy of 
burns will be discussed in an early issue of the Burned News Letter. 

Relief of pain: It is important to distinguish between pain and anoxia as 
a source of restlessness, anxiety and apprehension. Asphyxia or carbon mon- 
oxide poisoning may be a complication of burns received in buildings or closed 
compartments. Damage to pulmonary epithelium from hot or noxious fumes 
may produce pulmonary edema early or after a delay of several hours. Anoxia 
from these sources is not infrequent. Pain from an extensive 
burn can ordinarily be relieved by 1/4 grain of morphine. Larger 
doses of morphine are dangerous in the presence of anoxia. 
If no syringe is at hand, morphine gr. 1/4 may be placed under 
the tongue until dissolved. The intravenous injection of 1/6- 
or 1/8-grain doses may be indicated if peripheral circulatory f a i 1 u r e 
precludes effective absorption from an intramuscular or subcutaneous injection. 
Barbiturates, preferably nembutal sodium in 1 -grain dosage intravenously, are 
effective sedatives to allay the anxiety and restlessness of anoxia. It should be 
remembered that sensitivity to these agents is increased during shock. Pento- 
thal, if needed, should be used in analgesic rather than anesthetic dosage. Para^ 
aldehyde is contraindicated because it is a pulmonary irritant excreted by 

Oxygen therapy is indicated during resuscitation and for the treatment of 
anoxia. The positive pressure mask is contraindicated in the administration of 
oxygen for anoxia resulting from pulmonary edema due to the inhalation irri- 
tant gases. 

Treatment of burned area: Local treatment of the burned area should be 
accomplished with strict asepsis and operating room facilities. If the burned 
surface appears clean, no further cleansing should be done. Small blisters 
should not be disturbed, but larger ones may be punctured or aspirated without 
removal of the epidermis. Loose shreds of epidermis should be removed. If 
the burned surface is grossly soiled, the area and the surrounding skin for a 
considerable distance should be carefully and gently cleansed using cotton or 
gauze, neutral soap and water. Green soap and brushes should not be used. 
Too vigorous cleansing increases plasma loss and may precipitate circulatory 
failure. General anesthesia should be avoided. Evidence of irreparable dam- 
age to the deeper layers of the skin may not be apparent for several days, and 
excision in such cases should be done as a secondary procedure. 

The burned surface is covered with a single layer of dry or petrolatum 
fine mesh gauze so as to favor absorption of excessive wound exudate. Over 
this should be added a thick, smooth layer of gauze and cotton waste. In the 
case of an extremity, this should surround the entire limb. The dressing is 
secured by a firmly applied stockinette roller or elastic bandage. Immobilizatio 

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Burned News Letter, Vol. 5, No. 10 RESTRICTED 

of the part by splinting should be effected when feasible. Portions of an ex- 
tremity distal to the burn should be incorporated within the pressure dressing. 
The margin of safety between effective pressure and excessive compression is 
relatively small. The tips of the toes or fingers should be available for peri- 
odic inspection for several hours after the bandage has been applied. The princi- 
ple of infrequent dressings is especially desirable in the treatment of burns . 
In the majority of cases it will be practical to leave the dressing in place for 
from 10 to 14 days. 

In the treatment of impending infection penicillin is the drug of choice. 
Extensive fluid loss and depressed renal function increase the risk of renal 
complications from sulfonamide therapy. Penicillin should be administered in 
a dosage of 25,000 units every 3 hours, intramuscularly. In addition, 25,000 
units should be given intravenously at the time of the first intramuscular dose. 
Persistent shock warrants continued intravenous therapy to insure absorption. The V 
local application of sulfonamides, penicillin, or other antibacterial agents is not 
approved. Prophylaxis against tetanus is recommended for all cases with deep burns. 

Repeated dressings are to be avoided. In general, secondary dressings of 
unhealed burns are done to excise the late slough of deep burns or to apply skin 
grafts. These procedures properly belong to the reparative phase of surgical 

Reparative Surgical Management : The reparative phase of burn manage- 
ment is concerned with the removal of hopelessly devitalized tissue and the 
early application of skin grafts. It- seeks to prevent excessive scarring and con- 
tractures, but is not concerned primarily with the ultimate cosmetic result. 

The patient with extensive deep burns will tolerate frequent short operative 
procedures better than a single prolonged operation. Excision of burn slough 
is undertaken at from 10 to 14 days, or when demarcation is evident. If the in- 
volved area of deep burn is small, it may be excised and grafted at the same 
procedure. The excision of larger areas may be associated with considerable 
blood loss and this should be anticipated with coincident transfusion of whole 
blood. Significant bleeding at the time of excision of slough is, in itself, an in- 
dication to postpone skin grafting. An interval of from 3 to 5 days between ex- 
cision of slough and skin grafting permits more accurate restoration of hemo- 
globin values. A clean surgical appearance at this time is the best evidence of 
an adequately prepared wound. 

Skin grafting will be done commonly as a staged procedure during this 
interval. Systemic penicillin therapy is maintained. Granulating surfaces are 
prepared for skin grafting by excision of slough and the application of dry fine 
mesh gauze under pressure dressings for from 3 to 5 days. Split, or Thiersch, 
grafts are recommended. ' 'Stamp" grafts are acceptable when used to cover 

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Burned News Letter, Vol. 5, No. 10 RESTRICTED 

an irregular contour. "Pinpoint", "pinch", or Reverdin grafts are condemned. 
More complicated grafts, such as full thickness or pedicle grafts, should not be 
undertaken as part of the program of reparative surgery. It is expected that 
all areas injured by deep burns will be covered by skin grafts at the end of the 
fourth week after injury. 


Early active motion of epithelialized extremities is to be encouraged. 
Prolonged immobilization is not usually necessary and contributes to pro- 
tracted disability. 

Complete skin grafting should be done early, even though it be recognized 
that a more formal plastic operation will be required later. Operative proce- 
dures to improve function or for cosmetic effects are the responsibility of 
special centers for plastic surgery. CTB MED 151, March '463 

Used Gas Masks for Examination : The Bureau of Medicine and Surgery is 
anxious to learn the nature of the smoke which arises from fires aboard ship. 
One method of acquiring such information is to examine the canister, the face 
piece and hose of Navy service gas masks which have been worn as a protec- 
tion against smoke created by fire. 

Although the Bureau of Ships "Fire -fighting Manual" (Navships 688), 1943 
edition, states that the canister of the service gas mask provides protection 
against smoke only to a limited degree, it is known that in the absence of a 
BuShips rescue breathing apparatus, men have resorted to the use of the gas 
mask during fires . It is therefore requested that in such cases medical officers 
forward to the Bureau of Medicine and Surgery, Research Division, four complete, 
, used, gas mask assemblies which have been used as protection against smoke dur- 
ing fire aboard ship . It is important that these masks not be wiped or cleaned 
in any manner before shipping. The four assemblies should be accompanied 
by the following information, if it is available: 

1. A brief description of the fire. 

2. Proximity of the wearer to the fire. 

3. The density of the smoke to which wearer was exposed. 

4. The length of time spent in the presence of smoke: (a) without the 
mask, and (b) after donning the mask. 

5. The subsequent physical condition of the wearer, with an opinion as to 
the degree of protection furnished by the mask. 

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Burned News Letter, Vol. 5, No. 10 


The Control of Diseases Due to the Hemolytic Streptococcus: The preven- 
tion of streptococcal diseases requires the constant application of the basic 
principles designed to control the dissemination of respiratory-tract patho- 
gens. Chemoprophylaxis has proved a useful adjunct in preventive medicine 
provided sulf onamide-resistant organisms are absent. This limiting 
factor was discussed in the Burned News Letter of April 13, 1945. The need 
for chemoprophylaxis to prevent the implantation of the hemolytic streptococ- 
cus indicates that the fundamental precautions have been inadequately observed. 
Primary reliance for the control of the spread of streptococcal diseases must 
be placed on the recognized sanitary measures. Frequent inspections should 
be made and appropriate action carried out by medical officers charged with 
the responsibility of the health and welfare of naval personnel. It is pertinent 
to review the fundamental sanitary measures, which should be familiar to all, 
in order to emphasize their importance and applicability to the streptococcal 

(a) Proper housing of personnel should be provided according to the 
standards set forth in the Manual of the Medical Department. When double- 
deck bunks are used, head-to-foot arrangement is indicated. 

(b) Crowding in barracks, mess halls, ship's service, classrooms, swim- 
ming pools, theaters, dispensaries and other places where men intermingle in 
appreciable numbers should be avoided. 

(c) "Ventilation of quarters should be as free as possible day and night 
throughout the year, with attention being paid to proper heating and humidity. 

(d) Floors must be kept clean. Sweeping should be done in the proper 
manner using oiled sawdust. The use of steel wool on floors is not recom- 
mended. Oiling of wooden floors in barracks, classrooms, ship's services, 
and dispensaries is highly effective in trapping the dust on the floor and thus 
reducing the amount of dust and number of bacteria in the air. (See Burned 
News Letter of May 26, 1944 and Sept. 29, 1944.) 

(e) Frequent airing and sunning of bedding is important. Blankets and 
clothing should be handled gently to minimize the scattering of bacteria-laden 
lint and. dust particles. Experimental tests with oiled blankets have demon- 
strated the value of this procedure in diminishing the amount of lint and bacteria 
shed by them. The Navy is developing and testing oil emulsions to be added 
to the final rinse of laundered blankets to impregnate them with oil. 

(f) Cleanliness in galleys is essential. Food, utensils and dishes must be 
protected from bacterial contamination. Sanitary standards in dishwashing 
must be maintained. Adequate refrigeration must be available and utilized. 
Custards, filled cakes and dishes with mayonnaise dressings should be served 
soon after preparation. Open milk vats must be eliminated from the chow line 
and ladling of milk prohibited. 'The common drinking cup is a menace. Food 
handlers with upper respiratory infections should be removed from their work, 
and carriers likewise removed, especially at the time of an outbreak. 

Burned News Letter, Vol. 5, No. 10 RESTRICTED 

(g) Proper segregation of patients with streptococcal diseases is neces- ■ 
sary. These patients should not be transported to the hospital in an 
ambulance with patients who have other types of infectious diseases. Unit dis- 
pensaries and hospitals should provide adequate facilities for the care of 
contagious diseases. Thermometers, atomizer tips, needles, syringes and 
surgical instruments must be satisfactorily sterilized. Cross infections must 
be prevented by constant attention to the following measures: good ventilation; 
clean, well-lighted rooms; adequate bed spacing in properly designed isolation 
accommodations; the use of adequate equipment conveniently placed for steri- 
lization and disinfection; and a staff trained to, maintain careful technic. 

A fundamental factor in the dissemination of streptococci arises from the 
fact that patients with streptococcal tonsillitis and pharyngitis are not given 
the same careful isolation as are cases of scarlet fever, although they present 
a similar infection. The revised communicable disease manual of the Public 
Health Association recognizes this fact and scarlet fever, pharyngitis and tonsil- 
litis are included under the same heading with recommendation for 14 days ' 
isolation. A rational policy in handling streptococcal diseases has been pre- 
sented by Comdr. Alvin F. Coburn (MO, USNR, in The Military Surgeon of 
January 1, 1945. He emphasizes the importance of the isolation of all open 
streptococcal cases until free of infection in order to prevent the dissemination 
of the hemolytic streptococcus by dangerous carriers. (Prev. Med. Div. - 
J. K. Curtis) 


Classification and Antigenic Structure of Streptococci: Interest in the clas- 
sification of the streptococci has been stimulated by recent epidemics of 
streptococcal disease (outbreaks of scarlet fever) in the Navy. A brief review 
is therefore considered appropriate. 

Streptococci have been classified in the following ways: 

1. On the basis of activity on blood agar. 

(a) alpha, or viridans (methemoglobin producing strains) . 

Cb) beta, or hemolytic 

(c) gamma, or non-hemolytic 

2. On the basis of biological activity (Sherman) . 

3. On the basis of susceptibility to bacteriophage (Evans) . 

4. On the basis of antigenic structure (Lancefield) . 

(a) Groups A, B, C, D, E, F, G, H, K, L, and Mare distinguished by 
means of group specific substances, which are polysaccharides immunologically 
distinct for each group. These groups also have distinguishing cultural charac- 
teristics (such as differences in final pH produced in carbohydrate broths, etc.). 

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Burned News Letter, Vol. 5, No. 10 RESTRICTED 

The vast majority of human respiratory infections are due to group A organ- 
isms, nearly all of which are hemolytic. Groups are detected serologically by 
precipitin tests, employing absorbed serum from immunized rabbits. 

(b) Tvoes within the groups are distinguished on the basis of type- 
specific substances. For practical purposes, typing is limited to group A 
organisms of which there are more than 40 known types. Group A streptococci 
contain two type-specific substances, a protein designated "M" and a sub- 
stance of undetermined chemical composition designated "T". Types are de- 
termined serologically by means of precipitin and agglutination tests, employ- 
ing absorbed rabbit serum. The precipitin reaction depends entirely on the M 
substance and its corresponding antibodies, while agglutination may involve 
the M substance and its antibody, or the T substance and its antibody, or both. 
For complete antigenic analysis, both the precipitin and agglutination technics 
must be used, but for epidemiological purposes either method will suffice. 

The classification of Lancefield is the one in general use in epidemiologi- 
cal studies. Grouping and typing by the methods of Lancefield are carried out 
at the Naval Medical School, Bethesda, Maryland, as a part of the Navy's cur- 
rent studies on control of streptococcal infections. 

l|c J|C ^ ^ ^ 

The TTse of a Plasma Protein Fraction in Hemophilia : A substance in the 
euglobulin fraction in normal plasma which accelerates the clotting of hemo- 
philic blood was demonstrated by Taylor et al some years ago. During the last 
two years Doctor Taylor has repeatedly tested plasma fractions for the pres- 
ence of this material and has shown that it is very highly concentrated in Frac- 
tion I, and is also present in considerable amount in Fraction III- 2. 

Some clinical trials, using samples of Fraction I which are rich in this 
material, have been made under the direction of Dr. George Minot. These tests 
have shown that the clotting time of patients with hemophilia is reduced practi- 
cally to normal for a period of several hours following injection of doses rang- 
ing from 20 to 100 mg. of protein from Fraction I. (OEMcmr-139. Conn, Harvard 
Univ. CMR Bulletin #34.) 


Sheathing of the Retinal Veins in Multiple Sclerosis: Rucker has recently 
observed that sheathing of some of the retinal veins is occasionally encountered 
on ophthalmoscopy of ocular fundi which otherwise appear normal. This finding 
is usually indicative of disease of the central nervous system, most often of 
multiple sclerosis. 

Perivenous sheathing visible in the retina has been found both early and 
late in multiple sclerosis. It has been seen in patients who had had evidence of 

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Burned News Letter, Vol. 5, No. 10 RESTRICTED 

multiple sclerosis for only two weeks. As yet none of these patients has been 
followed over a long period of time. The finding has not been encountered in 
any type of retrobulbar neuritis other than that due to multiple sclerosis. 

The nature of the sheathing is difficult to interpret from ophthalmoscopy 
alone. As yet there has been no opportunity for pathological examination of 
the condition. The fundal picture bears a resemblance to a feature observed 
by a number of pathologists in sections of the central nervous system of per- 
sons who died of multiple sclerosis, namely, an accumulation of cells: around 
venules. It is not as yet determined whether this pathology represents a r e - 
action to primary degeneration of nerves or whether the venous disease i s 
primary. Thrombosis of the veins in the retina has not been observed. The 
sheathing is not the result of a so-called demyelinating process, for the nerve 
fibers of the retina do not have a myelin covering. (J.A.M.A., April 14, '45) 

sf: sfc jfc $c sfs 

Globin Solutions for Use as a Blood Substitute; It is estimated that each 
year nearly one and one-half million liters of packed red cells could be sal- 
vaged from the preparation of plasma for the Armed Forces and for the civil- 
ian population. By a relatively simple process, this hemoglobin can be trans- 
formed into a "modified globin" at a fraction of the cost of plasma production. 

From a blood donation of 500 c.c. it is possible to obtain about 250 c.c. of 
plasma (about 17 Gm. of plasma proteins) and about 24 Gm. of globin. This 
globin is equivalent in osmotic power to about 600 c.c. of plasma. Thus from 
a single 500 c.c. donation of blood it is possible to obtain the osmotic equiva- 
lent of about four donations. Investigations have been undertaken to determine 
more completely the physicochemical, physiological and pharmacological prop- 
erties of this modified globin. (Am. J. M. Sc., April '45 - Strumia et al) 

The standardization of the process of preparation of globin has proceeded to 
a point where globin solution can be obtained which, when injected at the rate 
of 10 mg. per kg. of body weight per minute into humans will produce a fairly 
constant rate of hemodilution without reactions. Minimal flush reactions may 
be controlled entirely by the rate of injection. 

Thus far, a total of 210 injections of modified globin solution have been 
given to 108 patients. The largest dose to any one patient has been 6,000 c.c. 

It has been definitely ascertained that erythrocytes of all types can be used 
for the preparation of globin. Further observations have -been made on the value 
of globin as a source of nitrogen for intravenous feeding. The value of globin in 

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Burned News Letter, Vol. 5, No.. 10 RESTRICTED 

the preservation of re- suspended erythrocytes for intravenous administration 
has also been studied with encouraging results: (OEMcmr-44 - Strumia, Bryn- 
Mawr Hosp, Pa. - CMR Bulletin #34) 


Effect of Bed Rest on Blood Volume of Normal Men; The : effect of three 
weeks of complete bed rest on the blood volume has been studied in six- experi- 
ments on five normal young men. In four of these men studies were also car- 
ried out during the course of reconditioning after rest. In addition, one of these 
men was studied before and after the surgical repair of an inguinal hernia. 

An average loss in blood volume of 572 cc. (9.3 per cent) occurred during 
the period of bed rest. This was almost entirely accounted for by a contraction 
of 518 cc. (15.5 per cent) in the plasma volume. The first week of recondition- I 
ing resulted in an increase in plasma volume to pre-bed rest levels but was 
accompanied by an apparent loss of erythrocytes so that the average increase 
of blood volume was only 235 cc. The subsequent increase in blood volume to 
the original level was due entirely to an increase in erythrocytes. 

The blood volume change during three weeks bed rest following surgical 
repair of an inguinal hernia in one man did not differ significantly from the 
changes observed in the same man after bed rest alone. (OEMcmr-413 - Taylor 
et al, Univ. of Minn. - CMR Bulletin #34) 


Circulatory Responses to Morphine Administered to Dogs i n Shock: In nor- 
mal unanesthetized dogs, morphine (2 mgm. intravenously) caused a sharp fall Q 
in blood pressure and cardiac output, and an increase in peripheral resistance, 
with gradual return to pre-injection levels in one hour. In some dogs with well- 
developed hemorrhagic shock, the same dose produced a temporary circulatory 
improvement (rise in cardiac output, blood pressure and peripheral resistance, 
and decrease in the difference of arterial and venous blood oxygen) but did not 
prolong survival. In dogs with traumatic shock, morphine made the condition 
worse as judged by these criteria. 

The difference in response to morphine in hemorrhagic and traumatic 
shock maybe related to the degree of vasoconstriction present. The 
peripheral resistance is much higher in traumatic than in hemorrhagic shock. 
The fact that morphine can increase the peripheral resistance after hemor- 
rhage suggests that it produces vasoconstriction in some region (perhaps the 
splanchnic area) sufficient to produce a temporary improvement in venous 
return. (OEMcmr-66 - Gregersen, Columbia Univ. - CMR Bulletin #34) 

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Burned News Letter, Vol. 5, No. 10, RESTRICTED 

Cancellou s Chip Bone Grafts: Mowlem has reported seventy-five cases 
of cancellous chip grafting for the restoration of contour and of continuity i n 
fractures of facial and cranial bones, mandible and tibia. All have been suc- 

Cancellous tissue from the ilium was obtained in the following manner: 
the ilium was exposed, and its crest and outer plate were freed from their 
muscular and aponeurotic attachments. A block of bone of sufficient bulk was 
then removed with an osteotome, and its cortical covering discarded. The re- 
maining cancellous mass was divided into chips of various sizes, usually 
about 1 by 0.5 by 0.1 cm. The bone chips were applied so that they overlapped 
the exposed bony margins of the defect as well as each other. No endeavor was 
made to produce a continuous surface, but care was taken to create a smooth 
contour. The chips were arranged in at least two layers, those in the outer 
layer covering the gaps between the chips in the lower layer. The wound was 
closed without drainage. 

Mowlem reports a case in which this technic was employed to fill a cranial 
defect. Within ten days the whole mass was sound and firmly united. Over a 
period of three years no absorption has occurred. (Lancet, Nov. 25, '44) 


The Metric System: The fundamental unit of the metric system is the unit 
of length, the meter; the unit of volume, the liter, is a cube of 1/10 meter side; 
the gram, the unit of weight, is 1/1,000 the weight of a liter of distilled water 
at 4° C, its temperature of greatest density. 

From the meter and gram are derived, by merely moving the decimal place 
the scientific measures of length required for geographic distances, the units 
employed in cytology (A, microns), those used in the measurements of atomic 
spacing and radiation (angstrom units), and all metric units of mass and vol- 
ume. The scientific units of velocity, acceleration, force, energy, work and 
power are simply and logically derived from the fundamental metric units. The 
complex units of all the pure and applied sciences may, with the aid of certain 
conversion constants, be derived step by step without break in logic. 

The universal use of the metric system in scientific work, its adoption for 
general purposes in many countries and its practical simplicity have always 
been sound reasons for the use of the metric system in medicine. 

Announcement by the Council on Pharmacy and Chemistry (J. A.M. A., Dec. 
4, '43) that New and Nonofficial Remedies, Useful Drugs, the Epitome of the 
U.S. Pharmacopeia and National Formulary and Interns' Manual (with the con- 
sent of the Council on Medical Education) as well as other Council publications 

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Burned News' Letter, Vol. 5, No. 10 


would henceforth give quantities and dosages exclusively in the metric or centi- 
meter-gram-second system marks a step of no little importance in the prog- 
ress of rational medicine. The immediate and practical stimulus to the Council 
in deciding to adopt the metric system exclusively in its publications was the 
occurrence of serious accidents in dosage due to confusion between the two 
systems commonly employed. 

The Royal Canadian Navy Medical News-Letter has announced that all 
weights and measures in this publication will be given in metric units. (March 
1, '45). 

In spite of its unchallenged superiority, the metric system still exists as 
an ideal to be achieved. Universal adoption of this system would be a manifes- 
tation of rationality and of interprofessional and international cooperation of 
great practical utility. 

It should be noted that the Supply Catalog (NavMed 116) utilizes the metric 
system and that the prescription forms (NavMed 148) are designed for use of 
it as well. 

For the convenience of those medical officers who are more familiar with 
the apothecaries' system and to encourage wider use of the metric system , 
tables of approximate equivalents of doses in the two systems are appended. 






1 ounce - 30 grams (Gm.) 

2-1/2 drams - 10 grams (Gm.) 

2 drams - 8 grams (Gm.) 

75 grains - 5 grams (Gm.) 

1 dram - 4 grams (Gm.) 

4 drams - 15 grams (Gm.) 

2/3 grain - 45 milligrams (mg.) 

1/2 grain - 32 milligrams (mg.) 

3/8 grain - 24 milligrams (mg.) 

1 /3 grain - 22 milligrams (mg.) 

/$/4 grain - 16 milligrams (mg.) 

45 grains - 3 grams (Gm.) 
30 grains - 2 grams (Gm.) 
15 grains - 1 gram (Gm.) 

1/6 grain - 11 milligrams (mg.) 
1 /8 grain - 8 milligrams (mg.) 
1/10 grain- 6.5 milligrams (mg.) 

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Burned News Letter, Vol. 5, No. 10 






10 grains 
7-1/2 grains 

7 grains 
6 grains 
5 grains 
4 grains 
3 grains 

2-1/2 grains 
2 grains 

1-1/2 grains 
1 grain 
3/4 grain 

0.65 gram (Gm.) 
0.5 gram (Gm..) 

0.45 gram (Gm.) 
0.4 gram (Gm.) 
0.32 gram (Gm.) 
0.25 gram (Gm.) 
0.2 gram (Gm.) 

0.16 gram (Gm.) 
0.13 gram (Gm.) 
0.1* gram (Gm.) 
65 milligrams (mg.) 
50 milligrams (mg.) 

1/12 grain 
1/16 grain 

1 /20 grain 
1/32 grain ■ 
1/64 grain 
1/100 grain 
1/120 grain 

1/160 grain 
1/210 grain 
1/250 grain 
1/320 grain 
1/640 grain 

5.4 milligrams (mg.) 
4.0 milligrams (mg.) 

3.2 milligrams (mg.) 
2.0 milligrams (mg.) 
1.0 milligram (mg.) 
0.65 milligram (mg.) 
0.54 milligram (mg.) 

0.4 milligram (mg.) 
0.3 milligram (mg.) 
0.26 milligram (mg.) 
0.2 milligram (mg.) 
0.1 milligram (mg.) 

Liquid Measures 






cubic centimeters 






cubic centimeters 






cubic centimeters 







cubic centimeters 






cubic centimeters 







cubic centimeters 






cubic centimeters 







cubic centimeters 






cubic centimeters 






cubic centimeters 







cubic centimeters 






cubic centimeters 







cubic centimeters 





7.5 cubic centimeters (cc.) 



5.0 cubic centimeters (cc.) 



4.0 cubic centimeters (cc.) 


fluid dram 

3.7 cubic centimeters (cc.) 



3.0 cubic centimeters (cc.) 



2.8 cubic centimeters (cc.) 

- 13 - 

Burned News Letter, Vol. 5, No. 10 RESTRICTED 

Liquid Measures (Cont.) 





2.0 cubic centimeters (cc.) 



1.8 cubic centimeters (cc.) 



1.2 cubic centimeters (cc.) 



1.0 cubic centimeters (cc.) 



0.9 cubic centimeter (cc.) 



0.75 cubic centimeter (cc.) 



0.6 cubic centimeter (cc.) 

' 8 


0.5 cubic centimeter (cc.) 



0.3 cubic centimeter (cc.) 



0.18 cubic centimeter (cc.) 



0.1 cubic centimeter (cc.) 



0.06 cubic centimeter (cc.) 


Responses in Neurosyphilis to Penicillin : When neurosyphilis is treated 
with penicillin, the response, as Indicated by laboratory tests, is much more 
rapid and more marked in the spinal fluid than it is in the blood. The response 
in the blood is delayed, and apart from temporary improvement, is much less 
likely to be sustained. 

A study of the symptomatic responses to penicillin indicates that all the 
improvement likely to occur will take place in from 90 to 120 days after com- 
pletion of a course of therapy in a dosage range of from 1,200,000 to 2,400,000 
units. The logical time for retreatment, therefore, appears to be between the 
third and fourth months after a preceding course of penicillin therapy. (OEMcmr 
403, Prog. Report #6 - Stokes, Univ. of Pa.- - CMR Bulletin #29) 


Booster Doses of Penicillin in Therapy of Subacute Bacterial Endocarditis: 
In a progress report on the study of 16 cases of subacute bacterial endocarditis 
treated by penicillin, Baehr states that 13 of the patients have recovered and 3 
have died. Two of the latter are considered failures in treatment. There have 
been no recurrences thus far. Heparin was not employed in 12 of the cases. 

The therapeutic problem is considered to have two aspects: sterilization 
of the blood stream and sterilization of the vegetations. A more or less con- 
tinuously adequate level of penicillin in the blood may achieve sterilization of 
the blood stream throughout the course of treatment, yet reinfection of blood 

Burned News Letter, Vol. 5, No. 10 RESTRICTED 

will recur soon unless there has been penetration of the vegetations by the 
penicillin sufficient to kill off the bacterial therein. A much higher concentra- 
tion of penicillin would seem necessary to secure adequate penetration into the 
vegetations than is required for sterilization of the blood. A method has there ■ 
fore been devised of using "booster doses" of 100,000 units intramuscularly 
several times a day in addition to the usual dosage of penicillin. The effect of 
a booster dose was to raise the blood level of penicillin to a very high peak 
within 20 minutes, e.g., up to 6 units per c.c. of blood serum. A second intra- 
muscular injection of 100,000 units given 20 minutes after the first injection 
was followed by a still higher rise of the penicillin level of the blood, t o a s 
high as 11.6 units per c.c. within 20 minutes after this injection; and the level 
did not fall below 5 units for more than an hour. 

Up to the present time, 6 patients have been treated with booster doses in 
addition to the usual dosage of penicillin. The experience with these cases indi- 
cates that booster doses, have served to facilitate permanent sterilization of the 
blood stream and of the vegetations resulting in recovery from severe, pro- 
tracted or recurrent infections. (OEMcmr-479, Prog. Report #2 - Baehr, Mt. 
Sinai Hosp., N.Y. - CMR Bulletin f30) 

* * 

The use of penicillin in the treatment of subacute bacterial endocarditis 
has been discussed in the Burned News Letters of August 4 and December 22, 


Inactivati on of Penicillin bv Gram-Negative Bacteria : Various Gram- 
negative bacilli commonly found in infected wounds were found to be- very re- 
sistant to the action of penicillin in concentrations up to 20 units per c.c. 
Higher concentrations of from 2,000 to 5,000 units per c.c. produced a definite 
bacteriostatic effect. Alkaligenes fecalis, on the other hand, was found to be 
very sensitive to penicillin. 

The activity of penicillin was progressively destroyed by the growth of 
these bacteria, particularly £. coli and Ps. aeruginosa. The rate of destruc- 
tion was greatest after eight hours. The degree of inactivation varied not only 
with the different types of bacteria but also with different strains of the same 

The mechanical removal of devitalized tissue and purulent exudate, f o 1 - 
lowed by the topical application of penicillin in concentrations up to 1,000 or 
2,000 units per c.c. at frequent intervals (8 hours or less), is suggested in the 

- 15 - 

Burned News Letter, Vol. 5, No. 10 RESTRICTED 

local therapy of infected- wounds to minimize the inactivation of penicillin by 
Gram-negative bacteria. (OEMcmr-62 - Altemeier, Univ. of Cincinnati - 
Ms. for publication.. CMR Bulletin #27) 


Rehydration of Dehydrated Survivors : In order to determine the most ef- 
fective method of rehydration of castaways by fresh water, such as rain water, 
studies were carried out on volunteers who were (1) thirsting and fasting, 
(2) fasting without thirsting, and (3) thirsting with a small food intake. 

The data indicate that in the starved, dehydrated survivor, ingestion of 
water alone fails to repair completely the fluid deficit, the lack of inorganic 
electrolytes being the factor which limits water retention. Under these cir- 
cumstances, the addition of small amounts of sea water to rain water for drink- 
ing is beneficial, but no more than 1 part of sea water to 3 parts of fresh water 
should ever be used.' If carbohydrate or salt (food or sea water) has been in- 
gested during the period of dehydration, supplementary sea water is' neither 
necessary nor desirable with the fresh water. 

Water loss from thirsting, in the presence of a small intake of carbohy- 
drate, results in an increase in concentration of extracellular fluid electro- 
lytes. This is reparable by water alone to a greater extent than is a compa- 
rable" deficit produced by thirsting and fasting. The data indicate that the effect 
of carbohydrate in conserving sodium is larger and of more importance in the 
physiology of body fluid than can be explained by its protein- sparing effect alone. 
(OEMcmr-478 - Butler and Gamble, Mass. Gen. Hosp. - CMR Bulletin #34) 


The Neurovascular Syndrome Produced bv Hype r abduction of the Arms; 
Wright has observed patients who have developed numbness, paresthesia, troph- 
ic changes, and even gangrene of the tips of the fingers as a result of prolonged 
hyperabduction of the arms while sleeping or working. These patients were 
studied to rule out the possibility of various diseases, including: Raynaud's syn- 
drome, thromboangiitis obliterans, intrinsic and extrinsic tumor of the cervical 
cord, ruptured nucleus pulposus in the cervical area, infectious polyneuritis, 
ulnar and median nerve injury, cervical rib and scalenus anticus syndrome. 

It was demonstrated that hyperabduction of the arms resulted in oblitera- 
tion of the arterial pulse. The question was raised as to whether this consti- 
tuted a normal or an abnormal phenomenon. An investigation of 1S>0 young adults 
revealed that obliteration of the pulse could be produced in each arm in approxi- 
mately 83 per cent of individuals . 

- 16 - 

Burned News Letter, Vol. 5, No. 10 RESTRICTED 

The mechanisms which play the most important part in causing this condi- 
tion are believed to be the stretching of the brachial plexus and the subclavian 
axillary vessels under the coracoid process, with some degree of pinching pro- 
duced by tightening of the pectoralis minor muscle, and pinching of the vessels 
and nerves between the clavicle and the first rib. Either mechanism or a com- 
bination of both may produce this syndrome. These normal anatomic arrange- 
ments occurring in the majority of individuals are capable of producing 
a pathologic syndrome after prolonged hyperabduction of the arms. This syn- 
drome is to be differentiated from the cervical rib and scalenus anticus syn- 
dromes. ^ (J. Lab. & Clin. Med., April '45) 


Efficacy of Some Therapeutic Agents for Tularemia : The use of antiserum 
in the treatment of tularemia has had extensive clinical and experimental trials, 
but the results have been inconclusive. The data which Foshay obtained from 
treating humans led him t o believe that the use of serum effects a significant 
reduction in morbidity and mortality; Hillman and Morgan found that the use of 
this antiserum in an outbreak of tularemia was without striking results. Francis 
and Felton concluded that antitularemic sera prepared from horses, sheep and 
rabbits, as well as from convalescent humans, showed no evidence of protective 
effect in white mice. 

The reports concerning use of the sulfonamide compounds in treating 
tularemia have also been conflicting. Few well- controlled laboratory studies 
of the efficacy of these compounds in treating tularemia have been reported. 

Various clinicians have reported satisfactory results in the treatment of 
tularemia by any one of several agents which have included neoarsphenamine, 
ferrous iodide, metaphen, acriflavine and autogenous vaccines. 

In controlled experiments Bell and Kahn have tested the following therapeu- 
tic- agents in the treatment of experimental tularemia in guinea pigs: sulfanila- 
mide, sulfadiazine, sulfamerazine, acriflavine, metaphen, iodide and bismuth 
(iodobismitol with saligenin) , arsenic and bismuth (bismuth subgallate and sodi- 
um paraminophenyl arsonate) , trivalent arsenic alone (mapharsen), antimony 
(stibopheri), penicillin and hyperimmune equine antitularemic serum. All of 
these substances, with the possible exception of penicillin, were used in amounts 
which proportionately exceeded the doses given patients. From their results 
they conclude that none of these agents is effective in treating tularemia. (Arch. 
Int. Med., March '45) 

- 17 - 

Burned News Letter, Vol. 5, No. 10 RESTRICTED 

Provocative Prolongation of the P-R Interval in Rheumatic Fever: Various 
investigators have shown that the prolongation of the P-R interval in patients 
with rheumatic fever frequently can be abolished by atropine. This suggests 
that the impairment of atrioventricular conduction may, in many cases, be due 
to a heightened vagal effect rather than to an intrinsic defect in the conduction 
mechanism. Gubner et al have presented a study indicating an increased sensi- 
tivity to vagal stimulation in patients with rheumatic fever as further evidence 
for this view. This does not necessarily signify a greater vagal tone as such. 
The action of the vagus is determined, not only by the release of acetylcholine, 
but also by the rate of destruction of acetylcholine by the tissue enzyme, cholin- 
esterase, as first shown by Loewi and Navratil. 

The activity of cholinesterase is greatly modified by the pH, its action being 
maximal in an alkaline medium and falling sharply as the pH shifts toward the 
acid side, as Glick has demonstrated. Gubner et al suggest that in rheumatic 
fever the inflammatory process and vascular changes in the region of the con- 
duction system, by lowering the pH and interfering with tissue nutrition, inhibit 
cholinesterase, thus increasing the vagal effect which is responsible for pro- 
longation of atrioventricular conduction. 

Impairment of atrioventricular conduction of considerable degree was in- 
duced in 12 of 16 subjects with rheumatic carditis by pressure on the carotid 
sinus. Similar pressure did not produce such impairment in 16 control sub- 
jects who had various infectious diseases including scarlet fever, pneumonia 
and upper respiratory infection. The effect was more marked when the initial 
P-R interval was from 0.18 to 0.20 second than when it was less than 0.18 sec- 
ond. It appeared that vagal stimulation intensified a latent impairment in atrio- 
ventricular conduction. 

The changes in conduction were maximal during the acute stages of carditis 
and tended to disappear as rheumatic activity subsided. Prolongation occurred 
more commonly when the patient was sitting rather than recumbent, and more 
often with left than with right carotid pressure. The preliminary administration 
of prostigmin augmented the response in many cases. These investigators sug- 
gest that this procedure may enhance the diagnostic value of prolongation of the 
P-R interval in rheumatic fever. (Am. J. M. Sc., April '45) 

i)c 3fc jfc i^C jf( 

New BuMed Publications : 

Diet Formulary. NavMed 502 : This is the first professional treatise- on 
diets and nutrition prepared by the Bureau of Medicine and Surgery. The manu- 
al measures 5-3/8" x 8-1/4", is bound in a water- and grease- rep el lent 
cover and contains 102 pages with index. The contents include a general discus- 
sion covering in part: caloric contents of diets, height and weight tables for men 

- 18 - 

Burned News Letter, Vol. 5, No. 10 RESTRICTED 

and women, carbohydrate contents, vitamins, minerals, equivalents, allow- 
ances, etc. The principal section is devoted to special diets in various 
diseases. Initial issue has been made to all medical officers, and stock for 
subsequent issue is available at the U. S. Naval Medical Supply Depot, Brook- 
lyn, New York. 

A Synopsis of the Philippine Mosquitoes. NavMed 580: This is a manual 
7-7/8" x 10-1/4" having a stiff cover and containing 98 pages. The contents 
consist of an introduction, key to the genera of Philippine mosquitoes, brief 
descriptions and epidemiologic discussion of the various species of the Philip- 
pine "genera, an index to genera, species and subspecies, and 10 pages of ana- 
tomical figures for identification. The work was carefully prepared and is up 
to date. Distribution has been made to medical and H(S) (epidemiology) officers 
having FPO, San Francisco, California, addresses. 

Epidemiology of Diseases of Naval Importance in Ch ina. NavMed 630: This 
is a "Restricted" publication 7-7/8" x 10-1/4" having 221 pages and a stiff 
cover. The purpose of this manual is to present to medical officers a condensed 
picture of the prevalence, distribution and epidemiology of infectious diseases 
of naval -importance in China, together with information on the distribution, habit 
and identification of vectors and reservoir hosts. The contents include an in 
troduction,with tables showing distribution of population, hospitals and medical 
workers, and distribution of physicians in certain large cities of China; 20 chap- 
ters devoted to the most common endemic diseases, and an appendix on mosqui- 
toes, flies, midges, fleas, ticks, poisonous snakes and intestinal parasites. Priir. 
emphasis is placed on those diseases which could involve large numbers of nava 
personnel and which may present epidemiologic and control problems different 
from those experienced elsewhere. Distribution has been made to medical, Hosp 
tal Corps and H(S) officers having FPO, San Francisco, California, addresses. 

Notes on Water Supply Ashore. NavMed 632 : This is a manual 7-7/8" x 
10-1/4", with a stiff cover and 34 pages, produced in limited number for use 
by classes in military medicine as a guide in water sanitation. This manual 
discusses problems relating to the sanitation of water, including supply and 
source , purification and defects in water systems. It is a pre -printing of a section 
which will appear in the Manual of Naval Hygiene now being revised. Distribu- 
tion has been made to the existing naval schools teaching military medicine. 

Notes on Waste Disposal, NavMed 638 : This manual contains 22 pages of 
text and drawings, and measures 7-7/8" x 10-1/4", and is bound in a stiff 
cover. Methods and responsibility for waste disposal are discussed, including 
human excreta, liquid waste or sewage and refuse. Distribution of a limited 
number of copies has been made for use in classes in military medicine. This 
manual is a pre -printing of a section which will appear in the Manual of Naval 
Hygiene now being revised. 

- 19 - 

•Burned News Letter, Vol. 5, No. 10 RESTRICTED 

Asiatic Schistosomiasis. NavMed 642: This is a "Restricted" manual, 
7-7/8" x 10-1/4" with self cover, 14 pages of text, illustrations and distri- 
bution. Its purpose is to present a concise, authentic summary 
of useful information on Schistosomiasis to the responsible officer 
personnel of the Medical Department of the Navy. Primary distribution has 
been made to medical and H(S) officers having a FPO, San Francisco, C ali - 
fornia, address. This manual was prepared as part of the "Snail Fever" pre- 
vention program and will be issued by the U. S. Naval Medical Supply Depot, 
Oakland, California, to naval activities in the Pacific Area. 

Louse Control. NavMed 653 : This manual measures 7-7/8" x 10-1/4" 
with self cover, having 19 pages of text and illustrations intended to present 
to the personnel of the Medical Department a concise guide to the prevention 
and elimination of louse infestation. The contents consist of two sections de- 
voted to the louse and prevention of infestation, and modern methods of delous- 
ing personnel and equipment. This includes the latest information on the use 
of DDT, including methods of dusting clothing while being worn, etc. An appen- 
dix covers precautions in handling methyl bromide fumigation and symptoms of 
poisoning, and lists the lousicides and equipment which are available through 
the Supply Catalog. This manual will be included as a section in the Manual 
of Naval Hygiene now undergoing revision. Distribution of "Louse Control" 

was made to all commissioned officers of the Medical Department. (Pub. Div., 

BuMed - G. G 


* * 

* * * # 


Public Health Foreign Reports: 




Number of Cases 



Feb. '45 

2 (2 fatal) 


Feb. 11-20, '45 


.Morocco (French) 

March 1-10, '45 



Belgian Congo 

Jan. 6-13, '45 



Feb. 17-24, '45 

379 (298 fatal) 


Feb. 3-10, '45 

156 (21 fatal) 


March 10-17, '45 


Typhus Fever 


Feb. 11-28, '45 



Feb. '45 

28 (5 fatal) 


Feb. 10-17, '45 ■ 

598 (48 fatal) 


Feb. '45 


Morocco (French) 

March 1-10, '45 



March 10-17, '45. 


Yellow Fever 

Gold Coast 

March 18, '45 

1 (suspected 

fatal ) 


March 20, '45 


(Pub. Health Reps., April 13, '45) 

- 20 - 

Burned News Letter, Vol. 5, No. 10 




Immunization against Yellow Fever. 

All Ships and Stations. 


15 Mar 1945 

Refs: (a) BuMed ltr P2-3/P3-K074) , of 13 May 1941; N.D. Bui. Cum. Ed. 
1943, 41-2027, p. 397. 

(b) BuMed ltr P2-3/P3-K074) , of 6 Aug 1941; N.D. Bui. Cum. Ed. 1943, 
41-2030, p. 402. 

(c) BuMed ltr P2-3/P3-K074) , of 21 May 1942; N.D. Bui. Cum. Ed. 
1943, 42-51, p. 427. 

1. This directive supersedes references (a) and (b). 

2. It is directed that Navy and Marine Corps personnel, civilian personnel trav- 
eling under the cognizance of the Navy Department, and dependents of naval 
personnel shall be immunized against yellow fever when being transferred to 

or traveling through defined areas where yellow fever is endemic. The vaccine 
shall be given, if practicable, 10 days prior to arrival. 

3. Defined areas are as follows: 

(a) In Africa and adjacent islands between 20° north latitude and 1 3° south latitude , 

(b) In South America between 13° north latitude and 30° south latitude. 

4. Yellow-fever vaccine may be procured by submitting a separate NavMed Form 
4 to medical supply depots or by letter to the distribution centers listed below: 

Medical Supply Depot, Brooklyn, New York 
Medical Supply Depot, Oakland, California 
Dispensary, Navy Yard, Portsmouth, New Hampshire 
Dispensary, Navy Yard, Boston, Massachusetts 
Dispensary, Navy Yard, New York, New York 
Dispensary, Navy Yard, Philadelphia, Pennsylvania 
Dispensary, Norfolk Navy Yard, Portsmouth, Virginia 
Dispensary, Puget Sound Navy Yard, Bremerton, Washington 
' Dispensary, Navy Yard, Pearl Harbor, Hawaii 
Dispensary, Naval Air Station, Jacksonville, Florida 
Dispensary, Naval Air Station, Pensacola, Florida 
Dispensary, Naval -Air Station, San Juan, P. R. 
Dispensary, Naval Training Station, Great Lakes, Illinois 
Dispensary, Naval Training Station, San Diego, California 
Dispensary, Submarine Base, Coco Solo, Canal Zone 
Dispensary, Naval Station, Guantanamo Bay, Cuba 
Dispensary, Washington, D. C. 

Post Dispensary, Marine Barracks, Quantico, Virginia 
U. S. Naval Hospital, Newport, Rhode Island 
U. S. Naval Hospital, Annapolis, Md, 

All ships and stations in the vicinity of the above-named activities shall procure 
their vaccine by having a responsible representative apply for it in person. 


- 21 - 

Burned News Letter, Vol. 5, No. 10 RE STRIC TED 

Advanced base activities shall be supplied from the nearest overseas medical 
supply depot or storehouse. 

5. Medical supply depots and other issuing activities shall be responsible for 
the proper storing, packing and shipment of yellow-fever vaccine and shall take 
necessary steps to insure that the vaccine is kept at or below a maximum tem- 
perature of 4° C. (39° F.) while in transit, and shall notify the requesting acti- 
vity as to expected time of arrival. The vaccine, after being received, shall be 
refrigerated immediately and kept at or below a maximum temperature of4°C. 
(39° F.) . 

6. The ampules of yellow-fever vaccine supplied are of two sizes, one contain- 
ing 5 cc. and the other 1 cc. of the concentrated vaccine. Each 5-cc. ampule 

is provided with a rubber- stoppered bottle containing 55 cc. of physiological 
sterile saline solution. Each 1-cc. ampule is accompanied by a smaller bottle 
which contains 11 cc. of the saline solution. The 5-cc. ampule, when diluted 
with the saline in the manner described below, will provide 55 cc. of diluted 
vaccine, sufficient for more than 100 injections. The 1-cc. ampule diluted with 
11 cc. of the sterile saline solution is sufficient for more than 20 injections. 
Diluted vaccine which remains unused after 3 hours must be discarded. While 
performing vaccinations, the ampule containing the diluted vaccine should be 
surrounded by ice, or other means of cooling. 

7. The technic of dilution and injection is as follows: 

(a) Using the large (5-cc.) ampule. When ready for use, sterilize, file, 
and break the neck of the ampule. Paint the rubber cap on the salt solution 
bottle (55 cc.) with tr. iodine. With a sterile needle and syringe, remove 
through the rubber cap 5 cc. of the salt solution and add this to the desiccated 
virus in the ampule. Suspend the vaccine in the saline solution by shaking the 
ampule or by gently forcing the fluid in and out of the syringe. When the vaccine 
has been completely suspended, draw the entire contents of the ampule into the 
syringe and inject this 5 cc. into the salt solution remaining in the saline bottle. 
This will provide 55 cc. of an approximately 1:10 dilution of yellow-fever vac- 
cine which is ready for use. Prepare the skin at a suitable area on the arm 
with alcohol or ether and inject subcutaneously 0.5 cc. of the diluted vaccine. 

(b) Using the small (1-cc.) ampule. Open the small (1-cc.) ampule in the 
same manner and using the same aseptic precautions as described above. Re- 
move 1 cc. of the saline solution from the 11-cc. saline bottle i Suspend the 
desiccated vaccine in this 1 cc. of saline as above. Inject this concentrated 
vaccine into the 11-cc. bottle of saline and mix thoroughly as above described. 
This will give about 11 cc. of approximately 1:10 dilution of yellow-fever vac- 
cine which is ready for use. 

8. Technic of vaccination: 

(a) Initial vaccination - one subcutaneous injection of 0.5 cc. of the diluted 
vaccine. . 

Burned News Letter, Vol. 5, No. 10 


(b) Routine booster Cor stimulating) vaccination - one subcutaneous injection 
of 0.5 cc. of the diluted vaccine 4 years after the initial vaccination if in endemic 
areas as defined. 

(c) Emergency booster vaccination - one subcutaneous injection of 0.5 cc. of 
the diluted vaccine in the presence of an epidemic and when in the opinion of the 
medical officer the risk of infection is serious. 

9. Reaction: A very mild febrile reaction may occasionally be noted in from 4 
to 7 days following the injection, but the reaction is so mild it seldom interferes 
with routine duties. 

10. The following data shall be recorded on the Immunization Sheet of the Health 

(a) Name of vaccine 

(b) Lot number 

(c) Date of vaccination 

(d) Signature of medical officer 

11. The following precautions shall be observed: 

(a) Every precaution must be taken to avoid giving the vaccine undiluted. 
Cb) After an ampule of vaccine has been diluted, any vaccine which remains 
unused after 3 hours shall be discarded. 

(c) Yellow-fever vaccine shall be diluted and injected only by medical officers. 

(d) Yellow-fever vaccine shall not be given concurrently with smallpox vac- 
cine. When both of these vaccinations are to be administered, it is suggested that 
yellow-fever vaccine be given first and that at least 5 days elapse before the 
smallpox vaccination is done. --BuMed. Ross T. Mclntire. 


To: All Ships and Stations. BuMed-T 


Subj: Medical Stores Requisition, NavMed-4 - Preparation 

and Submission of. 15 Apr 1945 

Refs: (a) Arts. 1164, 1165, and 1166, Navy Regulations. 

Cb) Ltr BuMed-T-RLJ, L8-2C072), of 1 May 1944; AS&SL Jan- Jun 1944, 
44-549, p. 372. 

(c) Ltr BuMed-T, L8-2C072), of 14 Jun 1944; AS&SL Jan- Jun 1944, 
44-684, p.. 416. 

1 . This letter supersedes reference (c) . 

2. Effective upon receipt of this letter, requisitions for medical stores (sup- 
plies and equipment) listed in the Medical Supply Catalog shall be prepared in 
quintuplicate in accordance with instructions contained herein and submitted in 
quadruplicate on NavMed-4 (requisition and invoice for medical supplies and 
equipment) direct to the nearest naval medical supply depot or storehouse. 

- 23 - 

Burned News Letter, Vol. 5, No. 10 RESTRICT S 

3. A separate NavMed-4 requisition shall be prepared for the following groups 
of items: 

(a) Biologicals, except serum albumin (stock No. SI -1945). 
Cb) Precious metals for dental use. 

(c) Other dental items (classes 11, 12, Sll, and S12). 

(d) Remaining Medical Supply Catalog items. 

(e) All items not listed in the Medical Supply Catalog. 

4. Medical Supply Depots are located at Brooklyn, N. Y.; Oakland, Calif.; 
Balboa, C. Z., and Pearl Harbor, T. H. Continental Medical Supply Store- . 
houses are located at Newport, R. I.; Norfolk, Va.; Charleston, S. C; New 
Orleans, La.; Seattle, Wash.; San Pedro, Calif.; and San Diego, Calif. 

5. Continental medical supply storehouses do not carry all Medical Supply 
Catalog items. Items carried by them will be indicated in the catalog by a 
symbol (letter "w"). In the near future instructions will be distributed to the 
field indicating the items carried by continental storehouses. Each activity, 
upon receipt of these instructions, shall insert the letter "w" in the symbol 
column of the catalog opposite the names of the appropriate items. 

6. Continental storehouses are authorized, within the limits of their stock, 

to make issues to any naval medical department activity. In view of the limited 
stock in the storehouses, the larger shore stations and naval hospitals shall 
submit their periodic replenishment requisitions to the nearest naval medical 
supply depot. 

7. Timely submittal of requisitions shall be made in anticipation of needs. 
Except in emergencies, medical stores shall not be requested by dispatch. No 
confirming NavMed-4 is required when medical stores are requested by dis- 

8. ' Requisitions shall be prepared for Medical Supply Catalog items in accord- 
ance with the following instructions. The data required in subparagraphs (a) 
to (1), inclusive, shall be entered on each sheet of the requisition. 


(a) U. S Enter the official name of the requistioning 

activity and the mail address. Vessels shall enter class and number after 
name. Example: (BB6). 

(b) DATE: Enter the date prepared. 

(c) REQUISITION NO: Requisitions shall be numbered 

consecutively in a separate series for each fiscal year, preceded by the letters 
"S.D." and followed by the last two digits of the fiscal year. Example: S.D.- 
1-40, S.D.-2-40, S.D.-3-40, etc. 

(d) ALLOTMENT NUMBER: Leave blank. 

(e) TOTAL ALLOTMENT: Leave blank. 

- 24 - 

. ' Burned News Letter, Vol. 5, No. 10 RESTR I CTED 



(h) AVAILABLE BALANCE: Leave blank. 

(i) AVERAGE COMPLEMENT: Enter average number of 

persons entitled to naval medical treatment except when prohibited by security 
instructions. Continental activities shall show the number of service personnel 
after the symbol (S) ; the number of civil personnel after the symbol (C) ; and 
hospitals the number of patients after the symbol (P) . 

(j) ACCOUNT NUMBER: Enter the accounting number as- 
signed the ship or station in the "LIST OF ACCOUNTING NUMBERS FOR SHIPS 
AND STATIONS," published by the Bureau of Supplies and Accounts. This num- 
ber may be obtained from the supply officer. If unobtainable, leave blank; the 
issuing medical supply depot or storehouse will supply the correct number for 
use on subsequent requisitions. 

(k) RESERVE FOR NMSD, BROOKLYN: . Leave blank. 

(1) CODE NUMBER: Enter code number assigned to your 

activity as indicated on previous requisitions. 

(m)BOX NUMBER: Leave blank. The issuing medical 

supply depot or medical supply storehouse shall indicate in this space the num- 
ber of container in which each item is packed. One or more copies of the requi- 
sitions shall be used as packing copies according to whether the material is 
for continental or overseas shipment. 

Cn) ITEM NUMBER: Each item of the entire requisition 

shall be numbered consecutively, beginning with 1 . 

Co) STOCK NUMBER: The stock number of each item, as 

indicated by the supply catalog, shall be entered in this column on the same line 
on which the name of the item begins. Items and stock numbers shall be ar- 
ranged in the exact order in which they appear in the supply catalog. The stock 
class number and name shall be typed at the head of each class of items re- 
quested. Double space shall be left between each class of items. 

(p) ITEM: List each item requested, beginning on the same 

line with the stock number, exactly as shown in the supply catalog, except that ir 
formation contained in parentheses may be omitted. Indicate the electric currer 
on which electrical apparatus will be required to operate, stating the voltage anc 
type of current (A.C. or D.C.). If alternating current, state also cycles and 
" phase. Example: 110-volt, DC; 220-volt, DC; 110-volt, 60-cycle, 1-phase. 

(q) UNIT: Enter on the same line with the stock number anc 

the first line of the item description, the "unit of quantity" as stated in the 
supply catalog ("One," "Pair," "Dozen," "Pkg," "100-gm bot.," etc.). 

Cr) MINIMUM STOCK: Substitute the words "on order, not received". 
Enter quantities previously requisitioned but not yet received. 

(s) ON HAND: Enter the quantity of the item on hand as 

indicated by the stock ledger and verified by recent inventory. Material ex- 
pended from the stock ledger, such as part bottles, etc., in the pharmacy, is 
not to be included. 

(t) REQUIRED: Enter the quantity required. In the event 

Burned News Letter, Vol. 5, No. 10 RESTRICTED 

the quantity on hand considerably exceeds the maximum stock quantity (see 
Manual of the Medical Department), as may be necessary for some specific 
purpose, an explanatory note must be made on the reverse of the form to jus- 
tify the apparent excess quantity requisitioned. Special care shall be observed 
to avoid requesting excessive quantities of biologicals, X-ray films, and other 
similar items which deteriorate within comparatively short periods. When 
practicable, items shall be requested in package or case multiples to eliminate 
unnecessary repacking and handling, and to reduce time and cost of issues, 
(u) VALUE: . . , Leave blank. 

Cv) PAGING: . When the listing of items required exceeds 

one sheet, each sheet shall be serially numbered near the bottom. 

(w) SIGNATURE: ........ Requisitions from ships and stations 

shall be signed by the senior medical department representative (from hospi- 
tals by the accounting officer) and approved and forwarded by the commanding 

(x) COPIES, DESIGNATION OF: The requisitioning acti- 
vity shall designate the respective copies as follows: 

Ribbon copy: ' 'original" 
Duplicate: "second' 
Triplicate: "third' 
Quadruplicate: "fourth' 
Quintuplicate: "fifth" (file copy) 



(y) SHIPPING INFORMATION: . . The second copy will 

accompany the bill of lading. 

(z) EXPLANATORY REMARKS: Indicate urgent need and 

specific delivery dates desired. State need for apparent large quantities of 
supplies or additional items of equipment. Explain need for nonlisted items 
and reason catalog items will not suffice. Enter reference to property survey 
when requesting replacement of equipment. 

9. NONLISTED ITEMS: When medical stores (supplies and equipment), not 
listed in the Medical Supply Catalog are required, a separate NavMed-4 requi- 
sition shall be prepared and forwarded to the Materiel Division, Bureau of 
Medicine and Surgery, Sands and Pearl Streets, Brooklyn 1, N. Y. The same 
procedure shall be followed in the preparation^ NavMed-4 requisitions for 
nonlisted items as that outlined in paragraph 8 above, except under "Stock No." 
the appropriate class shall be substituted for stock number. Example: "NL-3/ 
"NL-5," "NL-12," etc. When replacement parts or accessories for X-ray, 
electrically operated, or other equipment are required, an adequate description 
of the part and of the equipment item for which the part is required, or with 
which the accessories are to be used, must be stated, including the make, model 
serial number, part number, or such description as may be available, including 
electric- current data, when indicated, in order to enable the Materiel Division 

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Burned News .Letter, Vol.' 5, No. 10 RESTRICTED 

to determine accurately the material required. Requisitions "for nonlisted 
books (NL-15) shall state the exact title, author, edition, publisher's name, 
and list price of each book. Incomplete description of nonlisted material 
necessitates considerable needless correspondence and procurement delays. 
As a general rule, in the case of nonlisted material, several makes of an item 
are' available in the market, and competitive bidding is required. Therefore, 
commercial catalog references must be construed as descriptive but not re- 
strictive, unless sufficient justification is furnished for proprietary purchase. 
Each requisition for nonlisted (noncatalog) items shall be' accompanied by a 
statement explaining why catalog items will not meet the requirements or 
answer the purpose. Prepare six and forward five copies of NavMed-4 for NL 

10. INVOICES - NAVMED 255 AND 259: Upon receipt of requisitions (NavMed- 
depots and continental storehouses shall mechanically reproduce sufficient num ■ 
bers of copies of Medical Stores Invoices, NavMed 255 (a form consisting of an 
original and five attached copies) for domestic shipments or NavMed 259 { a 
form consisting of an original and eight attached copies) for overseas shipments 
to cover all conditions of shipment. Each invoice shall show quantities shipped, 
unit prices, extensions, class totals, and grand totals. Distribution of copies 

of NavMed 255 shall be made as follows: 

Original: To the requisitioning activity for receipt and return to the issuing 

activity for transmittal to Materiel Division. 
Second: To the Materiel Division for transmittal to Finance Division, 

BuMed - mail as soon as completed. 
Third: To the requisitioning activity for its files. 
Fourth: To the Materiel Division with second copy. 
Fifth: For use in preparing transfer requisitions. 
Sixth: For issuing activity's files. 

Distribution of copies of NavMed 259 (formerly NavMed 255-0), shall be ■ 
the same as for NavMed 255 except that the seventh, eighth, and ninth copies 
shall be used as additional information copies for consignees and transshipping 

11. COPIES OF INVOICES FOR BUMED: All copies of Medical Stores Invoices, 
NavMed 255 and 259, required by BuMed will be supplied by medical supply de- 
pots and storehouses preparing them. Requisitioning activities shall not send 
to BuMed after receipt of stores any priced and extended copies of NavMed-4, 
NavMed-255, or NavMed- 259. 

of a shipment, if any apparent shortage, overdelivery, or other error is found 
in comparing the invoice or packing copy of the requisition-, a full report thereof 

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Burned News Letter, Vol. 5, No. 10 RESTRICTED 

shall be made to the issuing depot or storehouse. If the issuing activity does 
not accept responsibility for the discrepancy, the stores shall be taken up as 
invoiced and shortages adjusted on the books of the receiving activity by ex- 
pending supplies or surveying equipment (NR, ch. 49, sec. IID. In case of 
missing narcotics, also comply with Navy Department Bulletin, article 44-102. 
When medical stores are lost or damaged by a Government or commercial 
carrier, the procedures outlined in art. 1903 of the BuS&A Manual and art. 
1840-5 of BuS&A Memoranda, shall be complied with. When medical stores in 
transit are lost by enemy action, the procedures outlined in art. 1120(4) and 
1130(6), BuS&A Manual, shall be complied with. 

TIES'. For reimbursement between appropriations, medical stores furnished 

to -other U. S. Government activities shall be issued on Invoice SandA Form 127. 
Six copies of this form shall be prepared and distributed as follows: 

Original: To requisitioning activity to be receipted and returned to issuing 

Second: To requisitioning activity to be receipted and returned to issuing 

Third: Requisitioning activity's file. 
Fourth: To Materiel Division, BuMed. 
Fifth: Requisitioning activity's file. 
Sixth:. Issuing activity's file. 

14. DEFENSE-AID ISSUES: Defense-aid issues are those made to foreign 
nations eligible to receive aid from the U. S. Government. When time will 

not permit reference to Materiel Division, BuMed, depots and continental store- 
houses may make emergency defense-aid issues of medical stores. Such issues ^ 
shall be made on BuS&A Form 127, three copies of which shall be receipted by 
an authorized agent of the foreign government concerned, and forwarded to 
Materiel Division, BuMed. These copies shall be clearly marked "Defense Aid 
Issue." See Chapter 30, BuS&A Memoranda, art. 3030-7, for detailed instruc- 
tions. --BuMed. Ross T. Mclntire. 



To: All Ships and Stations. 
Subj: Processing of Repatriates. 

1. For the purposes of this letter, United States Navy personnel who are re- 
turned to allied military control following capture by enemy forces, evasion 
of capture in enemy or enemy-held territory are classified as and hereinafter 
referred to as repatriates. 

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A16 2 

13 Apr 1945 

Burned News Letter, Vol. 5, No. 10 


2. In view of the fact that repatriates have, in almost every instance, encountered 
and survived extreme difficulties and harrowing experiences, it is the policy of 
the Navy Department to accord them special treatment and consideration upon 
their return. However, this policy is subject to special requirements of secur- 
ity, and special instructions for interrogation and briefing will be issued separ- 
ately through operational command channels. 

3. In keeping with the policy expressed above, repatriates who have been out of 
United States control for periods of 60 days or more shall, if they so desire, be 
returned to the United States by the earliest available transportation, and shall 
have priority in return over all classes of personnel except those returning on 
account of disability or urgent need of the naval service. Repatriates who have 
been out of United States control for less than 60 days may be returned to the 
United States or retained in the theater of operations in the discretion of the 
responsible commander concerned. 

4. While awaiting transportation, such personnel shall be processed as far as 
practicable, to the end that they may be put in a leave status as soon after re- 
turn to the United States as may be possible. 

5. The following shall govern the medical processing of subject personnel: 

(a) When such personnel first come under U. S. naval jurisdiction, they 
shall be referred to the nearest available naval medical facility for appraisal 
of their physical and mental health and admission to the sick list if necessary. 
(If the condition of the individual will permit return to the U. S. before com- 
plete medical processing, that should be the first consideration.) At the time 
of admission to the sick list and/or medical processing, a complete history 
and physical examination shall be made. Results of this procedure shall be 
recorded in the newly opened health record and on NMS Form Y. The words 
' 'special report - repatriate" shall be typed on the top of this form. In com- 
pleting this form, emphasis should be made of the following: 

(1) An accurate history of all illnesses or injuries incurred during the 
period involved. 

(2) An accurate description of all physical defects found, 

(3) A record of the positive findings of all laboratory and other proce- 
dures (X-ray, electrocardiogram, etc.) The original of the special Form Y 
recording this examination shall be sent to BuMed as soon as all of the indi- 
cated laboratory and other medical procedures are completed. 

(b) Wherever possible, medical processing and treatment should reach a 
point enabling subject personnel to be granted leave immediately upon arrival 
in the continental United States. No such leave shall be granted until the in- 
dividual concerned has been certified by a naval medical officer as physically 
and mentally qualified for such leave and as requiring no immediate hospitali- 


Burned News Letter, Vol. 5, No. 10 . RESTRICTED 

(c) The medical screening of subject personnel prior to their being granted 
leave in the United States shall include, in addition to routine clinical study, 
observation for vermin infestation, laboratory, study for amoebiasis and other 
intestinal infections, X-ray chest study for tuberculosis, serologic test for 
syphilis, and wherever indicated by reason of locality, study of blood smears 
for malarial parasites. An individual found to be. harboring any such infection, 
which may be of public-health significance, shall not be granted leave in the 
United States until he has received appropriate treatment. 

(d) Those individuals requiring medical treatment which can be prescribed 
and self-administered should be recommended for leave upon reaching the 
United States. Their leave orders shall specify that they report in to the naval 
hospital, for further observation and disposition, upon expiration of leave. 

(e) Those individuals requiring hospitalization or additional medical screen- 
ing shall be admitted direct to a continental United States naval hospital in the 
vicinity of the port of debarkation and further processed, in accordance with 

the provisions of BuPers Circular Letter No. 296-44 or of BuPers Circular 
Letter No. 196-43, except that rehabiliattion leave may be granted up to ninety 

(f) In considering appropriate disposition of those individuals requiring 
prolonged hospitalization due consideration shall be given to the wishes of the 
"individual. Likewise, (1) if the individual is to be returned to duty, full use 
shall be made of facilities for rehabilitation and furthering professional train- 
ing; (2) if the individual is to be separated from service, full use shall be made 
of facilities for rehabilitation and civil readjustment; and (3) those enlisted 
personnel who will be physically qualified for limited duty only will be recom- 
mended for discharge from service if they so desire; and (4) those who are 
physically qualified for service but unsuited for further duty for other reasons 
may be reported upon by a board of medical survey under the diagnosis ' 'No 
disease" (Unsuited for further naval service) and recommended for discharge. 

6. The following shall be the procedure for the settlement of the accounts of 
such personnel: 

(a) Paymasters are authorized to arrange pay accounts of subject personnel 
in accordance with Alnav 221, of 14 December 1944. 

(b) The Mobile Personnel and Settlement Unit is likewise authorized to 
make payments in accordance with Alnav 221, of 14 December 1944. This Unit, 
composed of representatives of the Bureau of Supplies and Accounts, the Bureau 
of Naval Personnel, and the Office of Shore Establishments and Civilian Person- 
nel, has been sent into the Pacific areas. One of its purposes is to settle in the 
field the accounts and claims of personnel who intend to remain in the Pacific 

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Burned News Letter, Vol. 5, No. 10 


area as well as of repatriates whose accounts and claims can be processed 
conveniently in the field while awaiting transportation. This Unit is also author- 
ized to settle claims, including dependents' benefits, of dependents of naval 
personnel in those instances in which such dependents reside in liberated areas 
outside of the continental limits of the United States. It is not intended that per- 
sonnel should be processed by the Unit, where such processing would not be 
essentially a convenience to them and in accordance with their desires. 

V. The following shall govern the further disposition of subject personnel: 

Ca) Upon return to the United States, repatriates who have been out of 
United States control for extended periods may be granted as much as 90 days' 
rehabilitation leave, provided they are medically qualified for such leave. 
Upon completion of leave, they will be ordered to the naval hospital nearest 
their home or leave address for medical survey to determine their physical 
fitness for duty. 

Cb) With respect to promotion, the policy of the Bureau of Naval Personnel 
is to give to returned officer and enlisted personnel who have, in the course of 
honorable service, fallen into the hands of the enemy as prisoners of war or 
who have escaped from such custody or evaded capture, special consideration 
in order to place them as soon as they are individually qualified, in the rank 
or rating and precedence they presumably would have acquired but for the fact 
of their capture, escape or evasion from the enemy. 

(c) In the reassignment of subject personnel after completion of leave, 
effort will be made to accommodate the desires of subject personnel as to type 
of duty and station. The Bureau of Naval Personnel shall determine type of 
retraining, if any, which may be necessary, in order to fit those who have been 
retained in the service for further efficient performance. Consideration will 
also be given in all matters of assignment to the fact that subject personnel 
may be in need of special assignment. 

8. Personnel in the process of discharge or release from service shall be 

afforded the usual discharge and readjustment facilities. 

— BuPers. Randall Jacobs. — BuMed. Ross T. Mclntire. 


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